- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $698.92 / $1,245.00 / $8,413.00
| Facility | | $698.92 | $1,245.00 | $8,413.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $698.92 / $736.09 / $1,307.18
| Professional | | $698.92 | $736.09 | $1,307.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,503.36 / $2,503.36 / $2,539.89
| Facility | | $2,503.36 | $2,503.36 | $2,539.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $806.98 / $1,421.71 / $1,890.80
| Professional | | $806.98 | $1,421.71 | $1,890.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $2,710.28
| Facility | | $606.10 | $606.10 | $2,710.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $774.22 / $1,014.71 / $1,786.31
| Professional | | $774.22 | $1,014.71 | $1,786.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $698.92 / $961.30 / $1,410.51
| Facility | | $698.92 | $961.30 | $1,410.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.00 / $870.00 / $930.00
| Professional | | $579.00 | $870.00 | $930.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.00 / $946.20 / $1,878.80
| Professional | | $4.00 | $946.20 | $1,878.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,248.00 / $9,541.00 / $14,589.00
| Facility | | $2,248.00 | $9,541.00 | $14,589.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $607.23 / $836.58 / $1,728.96
| Professional | | $607.23 | $836.58 | $1,728.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,366.10 / $8,957.00 / $26,542.00
| Facility | | $3,366.10 | $8,957.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,201.43 / $5,201.43 / $6,198.75
| Professional | | $5,201.43 | $5,201.43 | $6,198.75 |